Perspectives on 50 years of fetal monitoring from clinical leaders around the world

Susanne NeyeMidwife and former head of the labor ward at Universitäts-Frauenklinik Tübingen, Germany

1. How have advances in technology changed the way you work? Technology certainly plays a very important role in our work. When I first joined the labor ward here in 2003, we had two telemetry systems and no central monitoring unit. Now, we cannot imagine working without this technology – particularly as we need to care for several mothers at the same time, despite unfortunately having limited staff capacity.

Alongside technology, we also use traditional methods such as acupuncture and aromatherapy. These methods can help to stimulate the labor process or provide pain relief, for example. Face-to-face interaction remains crucial, though. We want to be there for the women in our care, so that we can support them in the best possible way as they give birth. The technology we use is valuable to us, but it needs to stay in the background. The mother and child must come first!

2. Which developments have surprised you the most during your time in the field of obstetrical care? I have been surprised by increases in the number of C-sections, and we should consider how this trend might affect our children. Babies are equipped to find their own way into the world – it’s the first challenge they must overcome in life. My concern is that children delivered via planned C-section may show less perseverance or ‘fighting spirit’ later in their lives. C-sections can be a real blessing, but it is important that the procedure is used judiciously. A C-section carries risks for the mother as well; it is their decision, but we will have to wait to see how the trend might impact the next generation.

Finally, from a technological perspective, I was surprised by advances that allow us to monitor the maternal pulse using a transducer placed on the mother’s abdomen. This delivers valuable information without requiring any additional equipment – that’s of great benefit to us.

3. How has the labor experience evolved from the mother’s perspective? In my time as a midwife, women have successfully fought for several changes. For example, partners may now accompany them to the birth, and the women themselves can move more freely or take baths during labor. In addition, the concept of ‘rooming in’ has become established – so women can have their newborn child in the room with them after birth. That is a positive development, and it is what many mothers want.

There are also more options now for pain management, for example epidural anesthesia. In the past, this procedure was quite rare and even considered risky by some, but now it is a lot more established in everyday clinical practice – and I believe it is a real blessing for a lot of mothers.

4. How have public and clinical attitudes changed with respect to mobility in labor? Public attitudes have certainly changed, with more and more women wanting to experience freedom in labor at their own pace. Movement can be extremely helpful in advancing the birth process and easing labor pains. It is often better to be mobile during labor than to lie on a bed in a fixed position, unable to do anything else.

With that in mind, we strive on a day-to-day basis to help mothers to stay mobile during labor. In certain situations, the mother’s mobility may be restricted – such as if we detect an unusual fetal heartbeat pattern and therefore need to perform continuous monitoring. Unfortunately, this type of monitoring isn’t always possible in every birthing position.

5. What future advances would you like to see in the field of labor and delivery that would improve your job or the mother’s experience? Firstly, I would like to be able offer mothers the care they need. In many cases, one-to-one care would be ideal, but even one-to-two care would represent major progress on a day-to-day basis. I want to offer women a calm, peaceful birthing environment, with few interventions and little external interference. Ultimately, it’s about being there when mothers need us, while allowing them time and space to be alone with their partners, for example.

In terms of technology, CTG has been a valuable development over the past 50 years, but sometimes the heartbeat patterns it generates can create questions that we find difficult to answer with clarity. It would therefore be useful if CTGs could provide additional information on how the child is currently doing – so that we can assess whether everything is OK or we need to intervene. In addition, it can sometimes be difficult to monitor the heartbeat of high-BMI patients unless the mother remains in a very specific position. This can heavily restrict the woman’s freedom of movement – so I would certainly welcome new advances in this area.

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